Prevention of Bilateral Coronary Obstruction During Valve-In-Valve TAVR With a Self-Expanding Valve: The BABICORN Procedure.

OBJECTIVE

We present a case of valve-in-valve transcatheter aortic valve replacement in an 85-year-old woman with severe bioprosthetic aortic valve stenosis at a high risk of left and right coronary artery obstruction. This risk was mitigated by a procedure combining both BASILICA and UNICORN (BABICORN [Bileaflet Alteration with BASILICA and Iatrogenic Cusp Obliteration Using Radiofrequency Needle]) for double leaflet modification.

KEY STEPS: Electrosurgical traversal of the right leaflet and creating the electrosurgical loop using 2 guide catheters and an Astato wire within. Electrosurgical traversal of the left leaflet and ballooning the leaflet fenestration. Creating the flying V and lacerating the right leaflet. Serial ballooning and ultimately lacerating the left leaflet. Deployment of the Evolut valve.

POTENTIAL PITFALLS: Catheter entanglement, inadequate leaflet laceration, and stroke or systemic embolization.

TAKE-HOME MESSAGE: The BABICORN procedure for double leaflet modification before valve-in-valve transcatheter aortic valve replacement with a self-expanding valve is technically feasible and preserves coronary flow in both native arteries.